Drop-out from addiction treatment: A systematic review of risk factors

Brorson, Hanne H.; Arnevik, Espen Ajo; Rand‐Hendriksen, Kim; Duckert, Fanny

doi:10.1016/j.cpr.2013.07.007

Cited by 506 publications

(517 citation statements)

References 147 publications

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“…Locating the focus for patient outcomes with the therapist supports findings from studies of addiction services (Brorson, Arnevik, Rand-Hendriksen, & Duckert, 2013) and adolescent Hoeve, & Vermeiren, 2013). These studies concluded that the simple study of patient variables in isolation was of limited value and the study of such factors as the alliance and therapist variables would be more useful, in part because they are variables that can be changed (de Haan et al, 2013).…”

Section: Discussionmentioning

confidence: 53%

The Contribution of Therapist Effects to Patient Dropout and Deterioration in the Psychological Therapies

Saxon

Barkham

Foster

et al. 2016

Clin Psychology and Psychoth

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Background In the psychological therapies, patient outcomes are not always positive. Some patients leave therapy prematurely (dropout), while others experience deterioration in their psychological well‐being. Methods The sample for dropout comprised patients (n = 10 521) seen by 85 therapists, who attended at least the initial session of one‐to‐one therapy and completed a Clinical Outcomes in Routine Evaluation‐Outcome Measure (CORE‐OM) at pre‐treatment. The subsample for patient deterioration comprised patients (n = 6405) seen by the same 85 therapists but who attended two or more sessions, completed therapy and returned a CORE‐OM at pre‐treatment and post‐treatment. Multilevel modelling was used to estimate the extent of therapist effects for both outcomes after controlling for patient characteristics. Results Therapist effects accounted for 12.6% of dropout variance and 10.1% of deterioration variance. Dropout rates for therapists ranged from 1.2% to 73.2%, while rates of deterioration ranged from 0% to 15.4%. There was no significant correlation between therapist dropout rate and deterioration rate (Spearman's rho = 0.07, p = 0.52). Conclusions The methods provide a reliable means for identifying therapists who return consistently poorer rates of patient dropout and deterioration compared with their peers. The variability between therapists and the identification of patient risk factors as significant predictors has implications for the delivery of safe psychological therapy services. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Therapists play an important role in contributing to patient dropout and deterioration, irrespective of case mix. Therapist effects on patient dropout and deterioration appear to act independently. Being unemployed as a patient was the strongest predictor of both dropout and deterioration. Patient risk to self or others was also an important predictor.

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Section: Discussionmentioning

confidence: 53%

The Contribution of Therapist Effects to Patient Dropout and Deterioration in the Psychological Therapies

Saxon

Barkham

Foster

et al. 2016

Clin Psychology and Psychoth

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“…33,34 Adults with substance use disorders who have lower levels of education have been shown to have poorer treatment outcomes and may be at particular risk for similar outcomes using web-based interventions. 1,4 Prior studies have reported that while most web-related content is written at the 10th grade level or higher, the average American reads at an 8th grade level or less, and this has been associated with a poorer understanding of web-based health information. 15,35 In this study, research support staff assisted patients during their initial use of the web-based TES intervention.…”

Section: Demographic Characteristicsmentioning

confidence: 99%

“…1 Barriers to the initiation of and retention in addiction treatment for vulnerable populations stem from the shortage of specialty treatment programs and perceived stigma by persons requiring treatment. [2][3][4] Service delivery in public sector, outpatient addiction treatment settings is further compromised by the need for increased staffing, funding, and access to evidence-based behavioral interventions. 5 Computer-and mobile-assisted web-based interventions are uniquely positioned to deliver complex, evidence-based behavioral interventions for the treatment of substance use disorders with high fidelity and minimal disruption to clinical work flow.…”

Section: Introductionmentioning

confidence: 99%

Recent Internet Use and Associations with Clinical Outcomes among Patients Entering Addiction Treatment Involved in a Web-Delivered Psychosocial Intervention Study

et al. 2016

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The acceptability and clinical impact of a web-based intervention among patients entering addiction treatment who lack recent internet access are unclear. This secondary analysis of a national multisite treatment study (NIDA Clinical Trials Network-0044) assessed for acceptability and clinical impact of a web-based psychosocial intervention among participants enrolling in community-based, outpatient addiction treatment programs. Participants were randomly assigned to 12 weeks of a web-based therapeutic education system (TES) based on the community reinforcement approach plus contingency management versus treatment as usual (TAU). Demographic and clinical characteristics, and treatment outcomes were compared among participants with recent internet access in the 90 days preceding enrollment (N = 374) and without internet access (N = 133). Primary outcome variables included (1) acceptability of TES (i.e., module completion; acceptability of web-based intervention) and (2) clinical impact (i.e., self-reported abstinence confirmed by urine drug/ breath alcohol tests; retention measured as time to dropout). Internet use was common (74 %) and was more likely among younger (18-49 years old) participants and those who completed high school (p G .001). Participants randomized to TES (n = 255) without baseline internet access rated the acceptability of TES modules significantly higher than those with internet access (t = 2.49, df = 218, p = .01). There was a near significant interaction between treatment, baseline abstinence, and internet access on time to dropout (χ 2 (1) = 3.8089, p = .051). TES was associated with better retention among participants not abstinent at baseline who had internet access (X 2 (1) = 6.69, p = .01). These findings demonstrate high acceptability of this web-based intervention among participants that lacked recent internet access.

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“…Most patients drop out of treatment as compared to those that complete [65]. It has been identified as a major mental health services challenge [88].…”

Section: Positive Outcomesmentioning

confidence: 99%

“…A favorable treatment outcome is heavily dependent on completion of treatment [65]. Studies have explored the interaction of specific factors and treatment outcomes including readiness for therapy, selfefficacy [66,67] treatment outcome expectations and perceived social support [68] as directly linked to positive outcomes in treatment.…”

Section: Treatment Outcomesmentioning

confidence: 99%

Review on Treatment of Substance Use Disorders

Njoroge¹

2017

J Addict Res Ther

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Services for mental and substance use disorders have typically been neglected, and in many countries segregated from mainstream health care with resources allocated not commensurate with the burden. The attention given to mental and substance use disorders cannot be compared to other diseases such as HIV/AIDS, Malaria, Cancer, and Diabetes among others. Mental and substance use disorders account to about 7.4% of disease burden worldwide. These disorders are responsible for more of the global burden than HIV/AIDS and tuberculosis, diabetes, or transport injuries.The increasing number of cases of SUDs globally presents a public health challenge that requires effective evidence based interventions. One of the major challenges is inadequate treatment for SUDs which mostly plague developing countries. It may be difficult to measure the efficacy of treatment as a result of unique patient characteristics that contribute to person's treatment experience. Care factors such as duration of treatment and length of stay have been studied as having influence on the outcome of treatment. Others include patient and environmental factors.Globally, poor treatment outcomes mostly reported include dropout rates as high as 90%; relapse rates as high as 91% and high after treatment mortality rates. Research findings have identified many evidence-based treatment strategies for managing substance use disorders, nevertheless there is a gap that continues to exist, that of a lack of success of effective interventions to be spread and implemented so as to improve the lives of those affected. Other studies have also reported these differences in the outcomes and effectiveness of treatment of substance use disorders.There is need for enhanced interventional research that aims at providing an overview of conceptual issues relating to factors that influence treatment outcomes and identifying gaps and directions for improving treatment and treatment outcomes. The fundamental objective of enhanced research in substance use treatment is to reduce the increasing prevalence rates of substance use disorders.

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Drop-out from addiction treatment: A systematic review of risk factors

Cited by 506 publications

References 147 publications

The Contribution of Therapist Effects to Patient Dropout and Deterioration in the Psychological Therapies

The Contribution of Therapist Effects to Patient Dropout and Deterioration in the Psychological Therapies

Recent Internet Use and Associations with Clinical Outcomes among Patients Entering Addiction Treatment Involved in a Web-Delivered Psychosocial Intervention Study

Review on Treatment of Substance Use Disorders

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